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General NPI Number Information
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NPI Number | 1598708224
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Entity Type | Organization
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Legal Business Name | WOMENS HEALTH OF BLAIRSVILLE
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 47 WEAVER RD SUITE A
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3136
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Country | US
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Telephone | 706-745-9220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1145
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City | BLAIRSVILLE
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State | GA
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Zip | 30514-1145
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Country | US
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Telephone | 706-745-9220
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVINS S DAVIS
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Credential | MD
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Telephone | 706-745-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 45765
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License Number State | GA
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